Clinical Atlas

Automated Fundus Camera
Clinical Atlas
Retina Disease
Myelinated-Nerves - A simple “birth mark.” This was
the first time the patient could see what previous eye
doctors told him concerning his eye.
Central Vein Occlusion - Photo was taken undilated during routine pre-testing with an asymptomatic
patient. The patient was dilated and the photos were
re-taken after dilation. The photos were the same quality dilated and undilated (the patient had cataracts so
the photos were not sharp). The patient was referred
to a retinal specialist for injections to restore her
vision.
Commotio-Retinae - Bruising from blunt force trauma. This patient was kicked in the eye 10 years prior
during a soccer event. Undilated photo.
Hollenhorst-Plaque - A small piece of cholesterol
that got stuck in one of the small retinal vessels. This
was a pre-test photo (undilated). The cholesterol could
not be found easily on the eye though it is obvious in
the photo. On a routine dilated exam, it would have
been missed looking at the patient’s retina. The camera
found it. The patient was advised to get a cholesterol
and neck artery (carotid) exam. If this happens in the
brain (cholesterol emboli), this would be a stroke.
Retinal-Hole - The retinal defect was out in the
periphery (next to the ora serrata), out beyond the
standard-7 shot mode. After switching to the manual
mode, this shot was easily taken. This was the first
time the patient could see the retinal hole after being
told about it for 15-20 years.
Pseudo Tumor Cerebri - Photos of a13-year-old
white female presented for a routine eyeglass exam.
Notice the optic nerve head swelling. Diagnosed with
pseudo tumor. This is a very strong example of how
important it is to perform retinal exams.
Symptoms of pseudo tumor cerebri:
•
headache, sometimes daily, sometimes severe,
not relieved by medication
•
hearing loss
•
impaired vision or eventual blindness
•
memory problems
•
Migraine attacks with unexplained triggers
•
nausea
•
pain behind the eyes
•
pulsating intracranial noises
•
shoulder and/or neck pain
•
tinnitus
Diabetic-Laser-Surgery - An eye with very poor
vision (20/100) taken by a tech recently graduated
from high school. This would have been an extremely
difficult photo to do with other cameras. The AFC-330
easily takes photos that were previously difficult to
take, or needing highly trained/ specialized staff.
Coloboma - This is a Panoramic set acquired by the
AFC-330 and auto-montaged with NAVIS-EX software: this displays a birth defect where a hole does not
close. Effects to vision is dependent upon location of
the hole. In this case the patient can fixate and it is
located in the peripheral retina.
Retinal-Detachment - This patient was seen the day
the detachment was in progress. The patient could
see the detachment moving across, and her losing her
vision as it happened. The patient was in surgery a
couple hours after this photo. This photo was difficult
to obtain because the patient had very little vision and
could not focus on the camera target. The AFC was set
to manual mode to get these shots.
Age-Related Macular Degeneration (AMD)
Dry-Macular-Degeneration - This was a pre-test
photo on an undilated eye from a new patient referred
from a retinal specialist for a low vision evaluation.
The patient was recently dilated and the pre-test photo
was clear to where the patient did not need to be dilated again. Nothing more could be done with her glasses
or magnifiers but her family with her got to see why
she could no longer see. It was the first time they saw
what was going on in her eye.
Wet AMD - Wet age-related macular degeneration.
This is a pre-test photo on an undilated eye. The
patient had seen the retinal specialist with dilation a
week earlier.
Disciform-Scarring - The end stage of wet macular
degeneration. These photos shown to the patient and
family conveyed the reason to why you “just can’t
make their glasses stronger” to see better. It is a good
tool for patients to come to understand the reality of
their vision and bring closure to it.
Drusen - This is a single 45 degree photo automatically acquired with the AFC-330: Drusen are yellow or
white build ups of extracellular material in the retinal
layers. It is normal to have presence of drusen as we
age, but large amounts can indicate signs of age-related macular degeneration (AMD).
Stereo-Macula - Viewing with a stereo viewer. The
AFC camera has the ability to take full 45 degree photos of the retina twice (separated by 3 degrees). When
doing the stereo composition you can use the “zoom
out function” to get back to the full view of the retina
(instead of zoomed in on the ONH) and voila! You
can get an entire retina in stereo. When you look at
this photo in stereo full-screen, you can see the retina
surrounding the macula is gone. There is just a central
island of retina left. “Stereo macula” shots can also be
used to see if there is any elevation (like a choroidal
nevus).
Glaucoma Disease Management
Glaucoma - The ability to obtain so many stereo optic
nerve head (ONH) shots and see these on a large 22
inch computer at full screen can change your diagnosis and treatment plan for patients. To be able to
set and focus on the ONH on-screen (instead of with
an uncomfortable bright light slit lamp light) is invaluable. You can really see what is going on with the
nerve - really a game changer. The stereo photos are
also incredibly easy to get.
Anterior Segment Images
Congenital Cataract - Routine photos can be taken
(internal nonmydriatic and external) on all patients
during pre-testing since the AFC-330 is so quick and
easy to use. Especially since it has the ability to interface with OfficeMate software. There is no need to
manually re-input patient demographics into Navis or
the AFC. The is just one of the everyday photos taken
during a routine pre-test.
Intraocular-Lens - A patient returned after cataract
surgery. She had extraordinarily large pupils (this
photo was undilated) and she was shown her new lens
put inside her eye. It was her “ah-ha” moment. She
realized what cataract surgery was. She was unable to
understand the concept of cataract surgery from the
explanations by the physician, the surgeon, or techs,
but she was able to understand the photo.
Iris-Nevus - A routine pre-test photo. It is quick and
easy with the AFC to document any changes in a patient’s iris nevus (freckles) over time.
Corneal Foreign-Body - This photo was taken by a
tech during the routine pre-test for a patient who had
a foreign-body sensation. The physician saw the photo
and was ready with an Algar Brush to remove the
foreign object when it was time to see the patient. This
is good legal-medical documentation of an external
condition with a “retinal camera.”
Basal-Cell-Carcinoma - This eyelid cancer was
confirmed via a biopsy by dermatology. This is one of
those conditions you want documentation to compare
to at the next exam and after excision.
Trichiasis – Anterior Photo acquired by the AFC-330:
note the eye lashes growing abnormally back towards
the eye. This can cause corneal scarring and potential
vision loss if untreated.
Arcus Senilis – Anterior Photo acquired by the
AFC-330: note the white ring visible in the peripheral
cornea. The ring is related to high cholesterol.
Conjuctival Cyst - Anterior Photo taken by the AFC330: This is a fluid filled mass within the conjunctiva.
Symptoms are discomfort and excessive tearing.